Page 6 - Kate Somerville Benefits Guide 2020 CA FINAL

ENROLLMENT

Medical Plan Choices

AETNA| HMO PLANS
With the HMO plan, you must choose a primary care physician (PCP) or medical group within the Aetna network. All of your care
must be directed through your PCP or medical group. Any specialty care you need will be coordinated through your PCP and will
generally require a referral or authorization. You will receive benefits only if you use the doctors, clinics, and hospitals that
belong to the medical group in which you are enrolled, except in the case of an emergency. Each family member covered through
your plan can choose his or her own PCP and can change them at any time.

AETNA | PPO PLAN
The Aetna Open Access Managed Choice (OAMC) POS plan requires that you meet a calendar year deductible before Aetna starts
paying for certain services. Once the deductible has been met, most services will be covered at a coinsurance or a copay. For
certain services, such as office visits and urgent care, Aetna has waived the deductible and cost sharing begins immediately. You
are free to seek medical care from both in and out of network providers. In order to receive the highest level of coverage under
the plan, simply obtain care from an in-network provider.

AETNA | HSA PLAN
With the Aetna Open Access Managed Choice (OAMC) HSA plan, you can pay for qualified healthcare expenses now and grow your
savings for future healthcare needs. This plan combines a High Deductible Health Plan (HDHP) with a special, tax-qualified Health
Savings Account (HSA). You can contribute tax-free money to your HSA up to IRS maximums. The money in your account is yours to
pay for current healthcare expenses - or you can save toward future healthcare expenses. More details about the HSA medical plan
are located on page 9. Similar to the traditional PPO plan, you can seek care from in network and out of network providers.

2020 HSA CONTRIBUTIONS LIMITS:
Individuals: $3,550 / Family: $7,100 / Age 55 or over Catch-Up Contributions: $1,000

FINDING A MEDICAL PROVIDER

Go to www.aetna.com. From the Aetna website, click on the link “Find a Doctor.” Next, under
“Guests”, select “Plan from an employer.” Enter your search criteria. You will then be instructed
to select a plan:

• Full HMO - Plan Category: Aetna Standard Plans | Plan: HMO
• AVN HMO - Plan Category: State Based Plan | Plan: Aetna Value Network HMO
• AWH HMO - Plan Category: Aetna Whole Health Plans | Plan: AWH – Southern CA HMO”
• OAMC PPO - Plan Category: Aetna Open Access Plans | Plan: Managed Choice® POS (Open Access)
• OAMC HSA - Plan Category: Aetna Open Access Plans | Plan: OA Managed Choice POS HDHP

6 KATE SOMERVILLE EMPLOYEE BENEFITS